VA Says It Has Funding to Begin New EHR Implementation

By Sandra Basu

Sen. Jon Tester (D-MT)

WASHINGTON—VA officials sought to reassure lawmakers that, while the price tag of its new EHR has not been determined, the proposed FY 2018 budget includes funds to begin the project. The agency plans to ask for any additional necessary funds in a later budget.

“We will come in the 2019 budget with firm numbers so we can have the appropriate discussion about whether this is something you can support,” VA Secretary David Shulkin told a Senate Committee on Appropriations subcommittee. “In the 2018 budget I believe we have the dollars to begin preparing for this process.”

At the beginning of June, VA announced it would start the process of adopting the same EHR system as DoD—known as MHS GENESIS—which at its core consists of Cerner Millennium. The goal is that, with VA’s adoption of the same EHR system, patient data will be able to seamlessly move between the departments.

While lawmakers have been supportive of the decision, they have also voiced concern during various House and Senate hearings that VA was not asking for additional money in its proposed 2018 budget for the EHR.

“In this case, we know this IT thing will cost some dough,” Ranking Member Sen. Jon Tester (D-MT) said at a Senate Committee on Veterans’ Affairs hearing. He suggested that VA should be asking for money for the EHR in its 2018 budget request.

Meanwhile, Sen. Brian Schatz (D-HI) pointed out at a hearing before a Senate Committee on Appropriations subcommittee about the president’s overall proposed FY 2018 budget for VA, “It seems to me pretty plain to see that we don’t have enough money in this budget.”

Schatz went on to note that the EHR is a “brand new hard cost” and wondered whether VA would have to “cannibalize” its budget to some extent.

At that hearing, responded that VA budget-builders “do not know the cost of it yet” and were currently unable to build it into the request but believe that the $200 million in the proposed FY 2018 budget will allow the agency to get started on the project.

At a separate House hearing VHA acting under secretary of Health Poonam Alaigh, MD, explained thatfor the first two years, we have enough in the budget to support the field assessments, going through the specifications and doing change management. It will be Year Three that we will be asking for additional and significantly additional funding to be able to implement it.”

EHR Timeline

The decision by VA to adopt the same EHR system comes after DoD and VA announced they were embarking on separate paths for individual EHR solutions in 2013—an idea that drew strong objections from lawmakers. VA said at the time that it would continue to use VistA as its platform and would modernize it, while DoD decided to seek a commercial solution, MHS Genesis.

While VA has now opted to adopt the same EHR platform as DoD, implementation could take 5 to 10 years, VA officials told lawmakers at a House Committee on Veterans’ Affairs subcommittee hearing.

“This is a huge implementation that will take years,” Alaigh said in discussing the FY 2018 budget request.

At that hearing lawmakers seemed surprised about what the implementation process would entail, even though VA is purchasing an off-the-shelf product.

Alaigh explained that, because VA has unique needs that are different from DoD’s, VA will not simply be adopting the identical EHR used by the military. In addition, she explained that the interoperability and seamlessness of care has to occur not only with DoD medical staff but also with all of VA’s community providers.

“This is one of the largest implementations ever for any healthcare system. You want to do it right. It’s patient safety. You don’t want to lose data. You want to make sure that all the users know exactly what to do. … This is not something you do with just the turn of the switch,” she said.

Alaigh explained that the first two years of the project are about “change management, going through the specifications and making sure the standards align.”

“In order to make sure the off-the-shelf product is customized to all of the different elements of care that we have incorporated into the VA, because the VA does such amazing things with team-based care and [Patient Aligned Care Teams], we will have to customize a lot of those standards and specifications. That is what will take time. We will have the frontline physicians and nurses all involved with this,” Alaigh said.

Alaigh said that VA is committed to providing a timeline for implementation once the agency has “the high-level implementation plan.”

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